CAROTID ENDARTERECTOMY PERFORMED AFTER PROGRESSIVE CAROTID STENOSIS FOLLOWING ANGIOPLASTY AND STENT PLACEMENT - CASE-REPORT

Carotid endarterectomy (CEA) is the treatment of choice for asymptomat ic and symptomatic disease causing greater than 60% internal carotid a rtery (ICA) stenosis. Recently, percutaneous transluminal angioplasty (PTA) with stent placement has been investigated as a therapeutic opti on for the treatment of ICA stenosis, In this report the authors docum ent CEA performed after PTA with stent placement and describe the path ological findings. A standard CEA was performed. The surgical interven tion was more difficult secondary to the following variables: the leng th of the exposure necessary to dissect out the metallic stent, the di fficulty with opening and cutting the artery, and the care required to remove the stent to avoid vessel wall perforation. Pathological exami nation of the specimen demonstrated classic atherosclerotic changes re vealing persistence of native disease. The metallic stent was embedded within the plaque. Many questions remain unanswered regarding the phy siological and biological changes that occur in the carotid vessel wal l after PTA with stent placement. It is concluded that CEA of a stent- containing carotid artery is feasible and should be considered as an a lternative when recurrent stenosis occurs after PTA.